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Peptic ulcer disease in endogenous hypercortisolism: myth or reality?

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Abstract

Many clinicians believe hypercortisolism is ulcerogenic. However, data from clinical studies show that prophylaxis for peptic ulcer disease is no longer recommended in patients receiving corticosteroid treatment. This has not yet been verified in endogenous hypercortisolism by controlled clinical studies. The purpose of the current study was to evaluate the relationship between endogenous Cushing’s syndrome (CS) and peptic ulcer disease and Helicobacter pylori infection. The study group contained 20 cases with CS resulting from ACTH-dependent endogenous hypercortisolism. The control groups consisted of 14 age- and gender-matched cases receiving exogenous corticosteroid therapy and 100 cases of dyspepsia with non-cushingoid features. Upper gastrointestinal endoscopy was performed on all cases. Biopsies were taken from five different points: two samples from the antrum, two samples from the corpus, and one sample from the fundus. A histological diagnosis of Helicobacter pylori infection was also obtained from evaluation of biopsy specimens. The frequency of stomach and duodenal ulcers did not vary between the groups (p = 0.5 and p = 0.7). Antral gastritis was less frequent and pangastritis was more common in cases with CS compared to the healthy controls (p = 0.001 and p < 0.001). The incidence of Candida esophagitis was more frequent in cases with CS compared to cases with corticosteroid treatment and healthy controls (p = 0.03). Histopathological findings and frequency of Helicobacter pylori based on pathology results did not vary between the three groups. It is possible that neither exogenous nor endogenous corticosteroid excess directly causes peptic ulcer or Helicobacter pylori infection. Prophylactic use of proton pump inhibitors is not compulsory for hypercortisolism of any type.

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References

  1. X. Bertagna, L. Guignat, L. Groussin, J. Bertherat, Cushing’s disease. Best Pract. Res. Clin. Endocrinol. Metab. 23(5), 607–623 (2009). doi:10.1016/j.beem.2009.06.001

    Article  CAS  PubMed  Google Scholar 

  2. E. Valassi, I. Crespo, A. Santos, S.M. Webb, Clinical consequences of Cushing’s syndrome. Pituitary 15(3), 319–329 (2012). doi:10.1007/s11102-012-0394-8

    Article  PubMed  Google Scholar 

  3. G. Arnaldi, T. Mancini, G. Tirabassi, L. Trementino, M. Boscaro, Advances in the epidemiology, pathogenesis, and management of Cushing’s syndrome complications. J. Endocrinol. Invest. 35(4), 434–448 (2012)

    Article  CAS  PubMed  Google Scholar 

  4. B. Swearingen, N. Wu, S.Y. Chen, S. Pulgar, B.M. Biller, Health care resource use and costs among patients with cushing disease. Endocr. Pract. 17(5), 681–690 (2011). doi:10.4158/ep10368.or

    Article  PubMed  Google Scholar 

  5. M.S. Broder, M.P. Neary, E. Chang, D. Cherepanov, W.H. Ludlam, Burden of illness, annual healthcare utilization and costs associated with commercially insured patients with cushing’s disease in the United States. Endocr. Pract. (2014). doi:10.4158/ep14126.or

    Google Scholar 

  6. H.O. Conn, B.L. Blitzer, Nonassociation of adrenocorticosteroid therapy and peptic ulcer. N. Engl. J. Med. 294(9), 473–479 (1976). doi:10.1056/nejm197602262940905

    Article  CAS  PubMed  Google Scholar 

  7. J. Messer, D. Reitman, H.S. Sacks, H. Smith Jr, T.C. Chalmers, Association of adrenocorticosteroid therapy and peptic-ulcer disease. N. Engl. J. Med. 309(1), 21–24 (1983). doi:10.1056/nejm198307073090105

    Article  CAS  PubMed  Google Scholar 

  8. H.O. Conn, T. Poynard, Corticosteroids and peptic ulcer: meta-analysis of adverse events during steroid therapy. J. Intern. Med. 236(6), 619–632 (1994)

    Article  CAS  PubMed  Google Scholar 

  9. M. Guslandi, Steroid ulcers: any news? World J. Gastrointest. Pharmacol. Ther. 4(3), 39–40 (2013). doi:10.4292/wjgpt.v4.i3.39

    PubMed Central  PubMed  Google Scholar 

  10. T.P. Dorlo, N.G. Jager, J.H. Beijnen, J.H. Schellens, Concomitant use of proton pump inhibitors and systemic corticosteroids. Ned. Tijdschr. Geneeskd. 157(19), A5540 (2013)

    PubMed  Google Scholar 

  11. L.K. Nieman, B.M. Biller, J.W. Findling, J. Newell-Price, M.O. Savage, P.M. Stewart, V.M. Montori, The diagnosis of Cushing’s syndrome: an Endocrine Society Clinical Practice Guideline. J. Clin. Endocrinol. Metab. 93(5), 1526–1540 (2008). doi:10.1210/jc.2008-0125

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  12. M.F. Dixon, R.M. Genta, J.H. Yardley, P. Correa, Classification and grading of gastritis. The updated Sydney System. International Workshop on the Histopathology of Gastritis, Houston 1994. Am. J. Surg. Pathol. 20(10), 1161–1181 (1996)

    Article  CAS  PubMed  Google Scholar 

  13. M. Rugge, R.M. Genta, Staging and grading of chronic gastritis. Hum. Pathol. 36(3), 228–233 (2005). doi:10.1016/j.humpath.2004.12.008

    Article  PubMed  Google Scholar 

  14. M. Guslandi, A. Tittobello, Steroid ulcers: a myth revisited. BMJ 304(6828), 655–656 (1992)

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  15. M. de Carpani Kaski, R. Rentsch, S. Levi, H.J. Hodgson, Corticosteroids reduce regenerative repair of epithelium in experimental gastric ulcers. Gut 37(5), 613–616 (1995)

    Article  Google Scholar 

  16. J.C. Luo, V.Y. Shin, E.S. Liu, W.H. So, Y.N. Ye, F.Y. Chang, C.H. Cho, Non-ulcerogenic dose of dexamethasone delays gastric ulcer healing in rats. J. Pharmacol. Exp. Ther. 307(2), 692–698 (2003). doi:10.1124/jpet.103.055202

    Article  CAS  PubMed  Google Scholar 

  17. J.C. Luo, V.Y. Shin, E.S. Liu, Y.N. Ye, W.K. Wu, W.H. So, F.Y. Chang, C.H. Cho, Dexamethasone delays ulcer healing by inhibition of angiogenesis in rat stomachs. Eur. J. Pharmacol. 485(1–3), 275–281 (2004)

    Article  CAS  PubMed  Google Scholar 

  18. J. Martinek, K. Hlavova, F. Zavada, B. Seifert, S. Rejchrt, O. Urban, M. Zavoral, “A surviving myth”—corticosteroids are still considered ulcerogenic by a majority of physicians. Scand. J. Gastroenterol. 45(10), 1156–1161 (2010). doi:10.3109/00365521.2010.497935

    Article  PubMed  Google Scholar 

  19. G.H. Elta, H.D. Appelman, E.M. Behler, J.A. Wilson, T.J. Nostrant, A study of the correlation between endoscopic and histological diagnoses in gastroduodenitis. Am. J. Gastroenterol. 82(8), 749–753 (1987)

    CAS  PubMed  Google Scholar 

  20. L. Atkins, E.B. Benedict, Correlation of gross gastroscopic findings with gastroscopic biopsy in gastritis. N. Engl. J. Med. 254(14), 641–644 (1956). doi:10.1056/nejm195604052541403

    Article  CAS  PubMed  Google Scholar 

  21. N.J. Carr, H. Leadbetter, A. Marriott, Correlation between the endoscopic and histologic diagnosis of gastritis. Ann. Diagn. Pathol. 16(1), 13–15 (2012). doi:10.1016/j.anndiagpath.2011.08.002

    Article  PubMed  Google Scholar 

  22. J.N. Aucott, Glucocorticoids and infection. Endocrinol. Metab. Clin. North Am. 23(3), 655–670 (1994)

    CAS  PubMed  Google Scholar 

  23. Y.S. Sari, E. Sander, E. Erkan, V. Tunali, Endoscopic diagnoses and CLO test results in 9239 cases, prevalence of Helicobacter pylori in Istanbul, Turkey. J. Gastroenterol. Hepatol. 22(11), 1706–1711 (2007). doi:10.1111/j.1440-1746.2006.04610.x

    Article  PubMed  Google Scholar 

  24. I. Baricevic, O. Nedic, J.A. Nikolic, B. Bojic, N. Jojic, Circulating insulin-like growth factors in patients infected with Helicobacter pylori. Clin. Biochem. 37(11), 997–1001 (2004). doi:10.1016/j.clinbiochem.2004.07.007

    Article  CAS  PubMed  Google Scholar 

  25. B. Kosan, O. Yuksel, I. Ustun, S. Koklu, F. Topal, M. Yilmaz, B. Ergul, S. Karaahmetoglu, E. Eskioglu, E. Altiparmak, Role of endogenous cortisol on Helicobacter pylori colonization. Clin. Biochem. 41(10–11), 917–919 (2008). doi:10.1016/j.clinbiochem.2008.03.004

    Article  CAS  PubMed  Google Scholar 

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The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Division of Endocrinology and Metabolism, Department of Internal Medicine, Cerrahpasa Tip Fakültesi, Cerrahpasa Medical School, University of Istanbul, Ic Hastalıkları Anabilim Dali, Endokrinoloji-Metabolizma ve Diyabet Bilim Dali, Cerrahpasa, 34303, Istanbul, Turkey

    Esra Hatipoglu, Asli Sezgin Caglar & Pinar Kadioglu

  2. Division of Gastroenterology and Hepatology, Department of Internal Medicine, Cerrahpasa Medical School, University of Istanbul, Istanbul, Turkey

    Erkan Caglar & Murat Tuncer

  3. Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Medical School, University of Istanbul, Istanbul, Turkey

    Serdal Ugurlu

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  1. Esra Hatipoglu
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  2. Asli Sezgin Caglar
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Correspondence to Pinar Kadioglu.

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Hatipoglu, E., Caglar, A.S., Caglar, E. et al. Peptic ulcer disease in endogenous hypercortisolism: myth or reality?. Endocrine 50, 489–495 (2015). https://doi.org/10.1007/s12020-015-0608-8

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  • DOI: https://doi.org/10.1007/s12020-015-0608-8

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